Ten-year experience on home care for patients with plasma cell disorders: bringing optimal therapy home

Advanced age at diagnosis, comorbidities and invalidating symptoms can debilitate multiple myeloma (MM) and AL amyloidosis (AL) patients, potentially precluding access to optimal therapy. The Associazione Italiana contro le Leucemie, Linfomi e Mieloma (AIL) has been providing home care to hematological patients in Italy since 1993. Between 2014 and 2023, 83 MM and AL patients received home infusion therapy through AIL in Bologna. Half were newly diagnosed, and half had undergone 1-7 prior lines of therapy. The median age was 79 years and 56% of patients had a performance status ≥ 2. The most frequently administered drugs included bortezomib (82%), daratumumab (14%), and bendamustine (9%). During the median 116-day therapy duration (range 1-750), patients received a median of 12 drug administrations and 12 home visits (range 1-59). Two-thirds of the patients never attended the outpatient clinic during home therapy. Ten newly diagnosed transplant-eligible patients were able to receive standard induction, restore their performance status, and proceed to transplantation. Twenty-one newly diagnosed transplant-ineligible patients received bortezomib and dexamethasone (with or without melphalan). At relapse, they were able to receive outpatient infusion therapy in 5 out of 11 cases. Elderly, frail patients, and patients in later relapse stages could maintain their quality of life, avoiding distressing hospital visits and remaining at home with their families while still receiving active treatment. Home therapy proved feasible in the 22 patients with AL in this study as well. Despite the limitations of a single-center retrospective data collection, our results show that home care in these patients is safe and feasible. We hope these preliminary findings may encourage the implementation of such programs by health policies in the future.